MEMBERSHIP FORM

ANNUAL DUES- $28.00 SINGLE / $30.00 FAMILY

NAMES:_____________________________________________________________________________

ADDRESS:___________________________________________________________________________

PHONE:_______________________________EMAIL:_______________________________________

SPONSER NAME & PHONE #:_________________________________________________________

 SPONSER NAME & PHONE #:_________________________________________________________

NUMBER OF XOLOS CURRENTLY OWNED (SIZE & VARIETY):________________________

_____________________________________________________________________________________

XOLO INTERESTS:  Breeding  Exhibiting  Obedience  Rescue  Education  Other? ____________

YEARS INVOLVED WITH THE BREED?________________________________________________

AMOUNT ENCLOSED:  Dues____________________         (payable to XCA-  US money order)

SIGNATURE:________________________________________DATE___________________________

(BY SIGNING THIS FORM  I AGREE TO ADHERE TO THE XCA BREEDERS CODE OF ETHICS)

RETURN TO:

JAN CARSON

PO Box 1344

Sloughhouse, CA 95683

          PHONE: (916) 357-5449 ------- EMAIL: XoloGoddess@wildblue.net